A 29-year-old woman presented to the spine clinic with newonset
pain in her right leg, accompanied by paresthesia. There were no
bowel or bladder symptoms. Magnetic resonance imaging (MRI) of the lumbar
spine revealed a lumbar disk herniation resulting in substantial spinal stenosis
and nerve-root compression (Panel A, arrow). She elected conservative treatment
with physical therapy and an epidural injection of glucocorticoids. A second MRI
obtained at follow-up 5 months after presentation showed resolution of the herniation
(Panel B, arrow). Lumbar disk herniation has an uncertain natural history. Data
from clinical trials suggest that patients who have herniated lumbar disks have similar
long-term outcomes whether they undergo surgery or elect conservative management.
In addition, the risk of subsequent catastrophic worsening without surgery is
minimal. This patient reported that she began to have back pain after playing volleyball
several years before presentation, whereas the pain and paresthesia in her
leg began 6 months earlier and were not associated with a precipitating event. Her
clinical symptoms resolved, and she was discharged from the clinic, with follow-up
recommended as needed.